Implantation of various medical devices requires forming a tunnel through the skin or body for placement of a catheter, cable, or other elongate member. For example, a cable must be passed through the skin to connect to many types of implantable devices. The cable may connect the implanted device to an external controller that provides electrical power, data, and/or control signals. Various systems may require tunneling a cable between two or more implanted structures. For example, it may be necessary to connect an implanted electronics housing in one anatomical location to an operative device in another location. In another example, certain medical procedures require placement of a catheter in a patient's body for an extended period of time.
A surgical tool used to pass the electrical cable through the skin is often referred to as a tunneler. Different types of tunnelers are available and suitable to particular methods of tunneling. Certain surgical procedures require a tunneler that can push through tissue in two directions. Such tunnelers are sometimes referred to as bi-directional tunnelers. Tunneler assemblies often are provided as part of a tool set including adaptors, plugs, and caps.
Existing surgical tools often suffer from several drawbacks. In the example of implantation of a left ventricular assist device (LVAD), a surgical team may be called on to tunnel a percutaneous cable between the LVAD and an external controller. Existing tools may require a lance to create a passageway through the skin and another tool to pull the cable through the passageway. Some tools may be designed to form the passageway and pull the cable, but these tools typically still require a cumbersome exchange of adaptors. Additionally, the elongate shape of the lance can make it difficult for a clinician to firmly grasp the tunneler and get sufficient leverage to push through tissue. Some tunnelers are designed with a handle removable from an elongate lance that performs the tunneling. The handle allows the clinician to manipulate the lance in the tissue. If the clinician needs to push the lance completely through the tissue, however, there must be a way to remove the handle. Existing designs lack an easy way to attach the handle to the lance in a robust manner and an easy way to remove the handle. For example, many tools require a user to screw a handle onto the lance, which adds significant time to the procedure. Moreover, when the handle is removed, the clinician lacks any finger holds for the last bit of pushing.
There is a continuing need for an improved tunneler, for example, one that is easy to use and allows for flexibility of use in a variety of tunneling methods. There is a continuing need for a tunneler that decreases the time for surgical procedures. There is a need for a tunneler with improved versatility, control, and ease of use to efficiently create a path through soft tissue. There is a continuing need for a lower cost tunneler useful in a variety of applications. There is a continuing need for a tunneler assembly that overcomes these and other problems.